


We Are Pilots

by AnnaNocturnal



Series: Requests and Challenges [22]
Category: Supernatural
Genre: Caretaking, Constructed Reality, Delusions, Gen, Healing, Hurt/Comfort, M/M, Mental Institutions, Nurse Dean, Past Child Abuse, Psychological Trauma, Sam Winchester and Mental Health Issues, Schmoop, Veteran Dean
Language: English
Status: In-Progress
Published: 2015-05-19
Updated: 2015-05-19
Packaged: 2018-03-31 06:39:18
Rating: Teen And Up Audiences
Warnings: Creator Chose Not To Use Archive Warnings
Chapters: 3
Words: 6,452
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/3968209
Author URL: https://archiveofourown.org/users/AnnaNocturnal/pseuds/AnnaNocturnal
Summary: <blockquote class="userstuff">
              <p>Sam Wesson is one of the longest-standing residents of Lawrence Regional Mental Health Center. The lines between reality and fantasy are severely blurred in his head, and he thinks that Dean Smith is his older brother, who he fights monsters with. Really, Dean is a nurse on Sam’s floor who’s been at the inpatient facility for years and has a soft spot for the kid. No one’s really sure why Sam can’t untangle fantasy and reality—the best guess anyone has is that it stems from long-standing emotional and mental trauma. Can Dean show Sam that the real wold isn’t so bad and heal the young man?</p>
            </blockquote>





	1. Supposedly Sam

**Author's Note:**

> Typically a story won't be cross-posted here on AO3 before it's completed (the exception typically being if the prompt originated here), but my darling **wtgw** specifically requested I cross-post this one for the community here, so here we go! Please note that it is a true WIP though. 
> 
> **Pairing** : Dean/Sam (Unrelated)  
>  **Prompter** : LJ user rookmist  
>  **Community** : None  
>  **Prompt** : [LINK](http://girlgotagun.livejournal.com/8537.html?thread=28505#t28505)  
>  **Rating** : R _(rating may increase later)_  
>  **Chapters** : ?
> 
> **Kinks** : mental health, reality vs. fantasy, caretaking/caregiving, hurt/comfort, angst
> 
> **Warnings** : None

_Holding close my secrets_   
_Naked broken pieces_   
_From the madness in what you do_   
_The fingers point right back at you_   
_What about my problems?_   
_The people try to solve them_   
_I guess I'm under the weather_   
_Since no one else belongs here, with me…_

—Shiny Toy Guns, “We Are Pilots” 

_~~**. wake . ** ~~ _

**From Dean Smith’s Journal – 20 January 2012**

_Started at LRMHC today. Not sure if this is the job for me. I thought I'd seen some crazy shit in the Corps, but this place is like another world. There are six patients in my caseload—_ individuals _, we're supposed to call them, cause they're physically stable—with diagnoses all over the board. Dr. Winchester says they’ll cycle out a lot as they get better and then get worse. “All except Samuel,” he said. ~~Samuel~~ Sam’s this kid—well, he’s 23—and John says that he’s been there longer than anyone. When we went past his room and he was introduced to me, he sort of turned his head, staring at me like he was trying to make his mind up about something. I asked Dr. Winchester what he was doing and he just goes, “He’s trying to assimilate you; figure out where you fit.” _

_And hell, maybe Sammy’ll have more luck than I have, ‘cause I sure as hell haven’t been able to figure it out ._

_~~**. wake . ** ~~ _

Dean Smith hadn't always planned on becoming a nurse. Far from it. Before the explosion, before the shrapnel, before the ripping and tearing of muscle and the steel plate in his shin and the medical discharge and the Purple Heart, the closest Dean had gotten to the civilian nursing profession was the nurse that he had wound up bending over the exam table at the VA when he went in for his annual physical. 

He had been a 68W, a combat medic. Two tours in Iraq, one in Afghanistan. It had gotten to the point that, by the time he was twenty-three, he was more comfortable in a war zone—and had spent more accumulative time in war zones over the previous five years—than stateside. He sacrificed everything to his service. His girlfriend, Lisa Braedon, had left when he was twenty-one, after he returned from his second tour and couldn’t handle being touched, couldn’t look at their son without seeing a kid his age blown apart in the streets. He couldn’t blame her. She never liked the military life anyway; had only stuck it out because he joined right after they found out she was pregnant. They were still friends; he still saw Ben sometimes. 

It was his third stint under the wire that brought everything crashing down. When the dust cleared after open fire, he had rushed out with the rest of his unit, starting transfusions and patching up wounds that were really too serious to be fixed with gauze and tape, ‘cause that’s what he was supposed to do. He held his brothers-in-arms hands as the light faded from their eyes. It was part of the job. He took down their names in the long list in his head; promised himself he would write their widows when he got back and try to help them find some sort of peace that would, honestly, probably never come. 

Then the bomb went off. Dean still didn’t know if he tripped it, or if it was one of the other Marines winding their way through the mess of bodies and blood-soaked dirt. It didn’t really matter. The air went impossibly hotter and his vision flashed red and then white and he fell as shrapnel tore through his shin, metal and rock digging deep into bone that would never heal quite right, held together by a sheet of titanium that would send shocks through his nerves when the air grew too cold or wet. 

Then they were patching him up; patching up his wound that was really too much to be held together by gauze and tape. 

He was lucky not to lose the leg, they said. Dean didn’t feel too lucky. He signed his discharge papers a month later, began a life of recovery and physical rehab and painkillers. 

The desk jockey in charge of finding job placement for wounded veterans had suggested nursing school—said it should mesh well with his MOS. Dean thought the guy was full of shit; wanted to tell him that taping together pieces of a body in the hopes that his brothers will be able to hold on _just a minute more_ when it would probably be kinder to just go ahead and put a bullet through their skulls was nothing like being a pill-pushing RN. But he didn’t have any other options, and he needed to begin to _assimilate to civilian life_ , so he enrolled in nursing school. 

In January of 2012, Dean Smith found himself at twenty-seven years old, with a sheet of titanium holding his leg together, a Purple Heart tucked away in the back of his dresser that he never brought out, a shiny new degree that confirmed he was a Registered Nurse, and a new job at Lawrence Regional Mental Health Center. That was three years ago. 

_~~**. wake . ** ~~ _

LRMHC was an in-patient facility with a under-capacity residential roster and an acronym that didn’t fit right on the tongue. Dean’s caseload fluctuated with demand, from one to six ‘individuals’ at a time. The one was always Sam. 

No one was one hundred percent sure what was wrong with Sam Wesson. He had been with them since he was sixteen; ten long years now. The doctors had guesses. Dean had guesses. Everyone had guesses but no one could offer any certainty. Sam was too trapped in his head, too unable to separate the fantasy in his head from the reality playing out around him. 

His official diagnosis was typed out in neat, sterile font on the first page of his case file, the words flicking through Dean’s field of vision every time he opened it to review any changes to Sam’s meds or therapy plans. 

_297.1 (F22): Delusional Disorder; mixed type – grandiose and persecutory types evident – with bizarre content. Continuous course. Delusions 4; Negative symptoms 2 (alogia)._

It was a fancy textbook way of saying that Sam was stuck in his own little world, pulling in everything around him and bending it to fit inside his accepted reality. When conflicts between reality and his fantasy world became too much, his verbal skills would decay and he would speak very little. It was part of the schizophrenia spectrum, with no hallucinations to support a diagnosis of schizophrenia. 

Dr. Winchester’s best guess was that Sam had some sort of chemical imbalance that could be fixed with the right cocktail of drugs and intensive therapy. Dean’s best guess was that Dr. Winchester was full of shit. 

Something had locked Sammy up tight in his head. The damage to the barrier between fantasy and reality in his head was a scar left from something that had happened to the kid. But Sam was considered an unreliable source for such information. And anyway, he wasn’t offering it. If you pushed too hard at that crack, if you hit the wrong nerve, Sam crawled back into the fantasy, tucking himself in tight, and didn’t poke his head back out for days. 

So Dr. Winchester kept trying drugs and Dean kept caring for Sam through the onslaught of the side effects of various chemicals coursing through his system. Everyone at LRMHC liked Sam, and they’d talk about the day when they’d finally get to see him leave, finally go home, once Dr. Winchester found that magic bullet that would make his brain fire right and bring him back to solid ground. But Dean had seen that haunted, avoiding look in a lot of men’s eyes and he knew that there was only one magic bullet for that, and it wasn’t sitting in the bottom of a prescription bottle. 

_~~**. wake . ** ~~ _

Dean arrived for his shift at eight in the morning each day, just in time to pass meds and watch the residents filter to their group therapy sessions. Group therapy was followed by individual therapy and medication monitoring until noon, which was lunch. 

He set Sam’s salad on the counter and waited for him to come pick it up. The kid was in an alogia episode, which means his verbal interactions would be limited, so Dean didn’t bother trying to talk to him much, didn’t call him over. It was harder on those days; like talking to a brick wall. He was never sure how much of what he said landed, or what it became deep in Sam’s mind. 

“How you doing, Sammy?” he asked, not looking up from the chart in his hands when the younger man came to get the salad. There was no answer before Sam was heading back to his table. Dean hadn’t really expected one. 

Meg cleared her throat. “You know you’re not supposed to bring them outside food.” 

Dean sighed, shutting the chart and setting it on the desk. “I don’t bring _them_ outside food; just Sammy.” 

“Their diets are an important part of their treatment.” 

Dean balked at her. It wasn’t her fault, really. Meg hadn’t been there long, so she didn’t really know the drill. Still, Dean sometimes got the distinct impression that she was just trying to stir up shit. 

“That food—“ Dean nodded to the nearest table, at the cafeteria-style Salisbury steak and glue-like mashed potatoes. “That food is an important part of their treatment?” He rolled his eyes. “Besides, I brought him a goddamned salad, not a bacon cheeseburger. The kid likes salad; leave him alone.” 

“You know Dr. Winchester would say that you’re encouraging his delusions with stuff like that.” 

“And what would the good doctor think about your blatant favoritism towards Cas?” Dean knew he had trumped her. The facility actually had a pretty nursing staff, and no residents got neglected or mistreated as far as Dean knew, but they all had their favorites. Meg’s was a young man named Castiel Novak; a schizophrenic who believed that he was an angel occupying a human ‘vessel’ on Earth as a soldier of God. 

Meg smiled wryly, her eyes landing on the man in question where he was eating his lunch. “What can I say. He’s a sweetheart. A little honey for his morning toast isn’t going to hurt him.” 

“I thought their diets were a very important part of their treatment?” Dean grinned at her. 

She rolled her eyes and walked away. Dean turned his attention back to Sam. 

_~~**. wake . ** ~~ _

_Brandon set a plate down in front of Sam, confirming Bobby’s fears that the angry little man would be their waiter for the evening. “Sidewinder soup and salad combo goes to Big Bird.”_

_Sam furrowed his brow, opening his mouth to speak, but before he could think of anything to say the man went on. He set a plate of—horrible, really—food in front of Dean. “TDK Slammer to Ken Doll.” The last plate he set in front of Bobby. “And a little heart-smart for Creepy Uncle.”_

_Dean had had enough of the waiter’s attitude. “What is your problem?”_

_“_ You _are my problem!” The waiter’s eyes bulged as he screamed, causing all three hunters to flinch. He stalked away without another word._

_Bobby watched him go, looking amazed that anyone, even someone in the service industry, could function with such anger boiling that close to the surface. “Oh, Brandon’s got his flare up in a bunch.”_

_“Yeah, there goes_ his _eighteen percent.” He poked at his salad with a wry grin._

_Dean turned his attention back to the case. “Anyway, chief ranger—I don’t think he believes in the Jersey Devil.”_

_“Oh, oh, by the way, Did he seem a little uh…” Sam searched for a polite way to say it and then gave up, “Stoned to you?”_

_Dean laughed. “Ranger Rick? Yeah. Definitely growing his own on the back forty and smoking all the profits.”_

_Sam smirked, running through their interactions with the man in his head. “He did seem to think there was something—”_

_Dean cut him off with a low moan, his mouth full of food. “Oh, that is a good sandwich.”_

_“What the hell did you get?” Bobby asked, giving Dean’s lunch a look like it might haunt his dreams later._

_Dean turned the placard at the center of the table around, slamming it down triumphantly for the other two to see. “New Pepperjack Turducken Slammer—limited time only.” The tone in his voice seemed to suggest that he had scored big by ordering it before it was discontinued._

_Bobby grunted disapprovingly. “Bunch of birds shoved up inside each other. Shouldn’t play God like that.”_

_“Hey!” Dean looked offended. “Don’t look at me sideways from that…that Chinese chicken salad there, okay? This is awesome.” He gave the sandwich an almost worshiping look. “Like the perfect storm of your top three edible birds.”_

_Sam raised an eyebrow at him, astounded that anyone could stomach that horror of a sandwich. “All right… anyways, um…” He tried to remember what he had been saying before the conversation had devolved into an assessment of the merits of a chicken in a duck in a turkey. “The ranger did seem to think there was something out in Wharton Forest.”_

_Bobby shrugged, figuring it was their best lead. “Well, I’d say it’s safari time.”_

_At that point all three whipped their heads around as shouting broke out in the restaurant. “She’s big-boned!”_

_Brandon was sneering at a man who was steadily turning redder in the face with outrage. “Look at her! You’re telling me she’s not fat?”_

_“Hey,” another waiter broke in, trying to dissipate the rapidly-escalating situation._

_“Up yours, Mike!” Brandon spat, whipping his apron off and slamming it down on the counter. “Shove it right up yours!”_

_Dean waited a beat after Brandon had stormed out before shrugging. “Well, anyway. Back to bigger and better things.”_

_~~**. wake . ** ~~ _

“Sammy?” Dean asked, waiting for the man’s hazel eyes to rise to meet his. “You hear me?” 

Sam nodded but didn’t answer. He pushed the empty salad container forward and Bobby, the head of custodial services, picked it up and tossed it into the trash can. Dean smiled at the older man, shrugging as he looked questioningly at Sam and then back at Dean. 

Dean waited until the man moved on to the next table and then leaned in towards Sam, his voice low. “What’re we hunting, Sammy?” 

He saw the flicker in Sam’s eyes as the words hit, as he assimilated them. “Don’t know. Jersey Devil, maybe…” He shifted and his eyes raised back up from the table to meet Dean’s, searching. “Rats don’t shake their ass, Dean.” He frowned. “It’s two shakes of a lamb’s tail. Or you don't give a rat's ass.” 

Dean laughed. “Sorry, Sammy. I’ll remember that.” 

_~~**. wake . ** ~~ _

Dean thought that Sam was probably abused. There was no proof to back his theory; he had been brought in after being pulled from the streets, tagged as a runaway, and made a ward of the state back in 2005. He had been sixteen. The kid had been in a completely dissociated state at the time, ranting about his soul and Lucifer and God missing from the equation. In his initial seventy-two hour observation, he hadn't slept more than two minutes before he was lurching up again, eyes wide with fear. That had been seven years before Dean started at LRMHC. The nurse had actually been across the world, on his first tour in Iraq. But the details were all packed neatly into his case file. 

Samuel Wesson might not even be his real name, Dean knew. He had been brought in as a John Doe, had told them his name two months after coming to LRMHC. Dean knew there was no record of birth that matched the name and the year. There was also no known match for his fingerprints in the system, and no response to the alerts of a found teen across the US. After a time they started to treat Sam like a corpse, had filtered through dental records for patients about his age for months without finding a match. Sam swore he had been born in Lawrence, and that his mother had died in a fire when he was an infant. For awhile the police had chased this lead. Then Sam revealed that it had been a demon that had set the fire after feeding him his blood to give him psychic abilities. At that point the police pretty much threw their hands up and Sam’s case went cold. 

So Dean had no proof that Sam had been abused. But when he tried to think of what could cause such a vicious break with reality—especially when the fantasy world the man preferred was often so much more violent and hopeless than the real world—he always landed back at that conclusion. Something terrible had happened to Sam, and when he couldn't escape in the physical world he fled into fantasy, locking himself up tight in his mind where he could protect himself, could save the world. 

Dean didn't know how to help Sam detangled the crossed wires, how to help him find the path back to reality or how to illuminate the sharp contrasting colors of the fantasy to show Sam how artificial they were. No one did. But Dean wanted to. 

Sam thought that Dean was his brother. It was probably something in the way Dean looked out for him, the way he called him Sammy or stood up for him when Dr. Winchester was too harsh or when Crowley—a snarky English-born man with narcissistic personality disorder mixed with something unspecified on the schizophrenia spectrum and who called himself the King of the Crossroads—bullied him. 

But whatever it was, Sam had assimilated Dean into his world as his older brother. And Dean had decided to operate within Sam’s parameters in his care, letting him think that. Dr. Winchester didn't like it; he said that Dean was encouraging Sam’s dissociation, legitimizing the delusions. But Dean didn't know any better way to help the kid. 

Or at least, he didn't for a long time. Not until the day that Sam gashed his hand open.


	2. Back In

_She knows the human heart_   
_And how to read the stars_   
_Now everything's about to fall apart_   
_I won't be the one who's going to let you down_   
_Maybe you'll get what you want this time around_   
_The trick is to keep breathing…_

—Garbage, “The Trick is to Keep Breathing”

**_~~. wake .~~ _ **

**From Dean Smith’s Journal – 3 April 2013**

_When I went back to work today Sammy was a wreck. I guess it didn’t stick when I told him that I would be going on vacation last week. He said I had been to Hell. Legit, serious-business Hell. He wanted to know how I got out, and Cas swore up and down that he had ‘raised me from the depths of perdition’ or something. I tried to tell Sammy it wasn’t true. He thinks Cas might actually be an angel. Sometimes the kid makes my head hurt._

_I had to dodge him when he swung on me, screaming that I must be a demon. Bobby held him back until we managed to get him calmed down. Then he just hugged me for awhile._

_It was… I don’t know. I haven’t felt that at-ease with anyone touching me since my second tour. And maybe Sammy’s just ahead of the storyline, cause I probably _am_ going to Hell for reacting that way to one of my patients._

**_~~. wake .~~ _ **

In the evenings Dean played cards with Sam. It was a pretty good challenge, despite the years of playing hands in the barracks during odd downtimes that could be interrupted at a moment’s notice. Keep a deck of cards on you. That was important. It would save you from the boredom; save you from living too much in your own head. Dean still kept a pack in his work bag. 

It was a challenge with Sam, though, because you could never be completely sure whether he was reacting to the hand they were playing, or the hand he thought they were playing. 

Sometimes Sam thought they were playing for years.

Dean wished he could win the years back. 

It had taken Dean a long time to get the hang of Sam’s world. It wasn’t linear; didn’t run in order. Scenes would replay, and chunks would be missing. The story was complicated, hard to figure out. Bad guys were good guys and vice versa, depending on how Sammy was feeling that day, what he needed to do to make the world fit together right. 

“Wanna play for years, Sam? Whaddaya say, ten? Get you outta here; get me right again?” 

The younger man grinned and shook his head; tossed a penny across the table into the pot. “Never again, man. Raise you.” 

Dean wasn’t sure how it happened, but the mason jar that he and the other nurses threw spare change in for poker chips fell off the table. He and Sam both reached for it, tried to stop it. They both missed, and the jar shattered apart on the tile floor. 

Sam overbalanced, his chair teetering, and he threw his hand out to catch himself. 

There was a beat of tense silence as Sam righted himself, brought his hand up to look at the wide gash that had opened there. A jagged piece of glass stuck out, and he gently grabbed the edge and pulled it out, making Dean wince as he held it up to the fluorescent lighting, clear glass splashed crimson. 

“Sammy?” Dean asked carefully, hesitantly. There was a flicker of something in Sam’s eyes as they lowered from the glass to meet Dean’s, a look of confusion as his gaze flitted over the room. And there was some difference there, some distinct awareness that wasn’t there before, and Dean knew, just _knew_ deep in his soul, that Sam was actually _there_. 

“What’s going on?” Sam asked. “This place is… I know it, but it’s…”

Dean waited, breath baited. He should be tending to the cut, should be filling out incident reports and bandaging Sammy up. But he waited, afraid to break the only thread of reality that he had ever seen Sam grasp onto. 

“It’s like I’ve seen it before, but never really… _looked_ at it, I guess. What’s going on? How did we…” Sam winced as though his head hurt. “Where’s Adam?”

“Adam?” Dean’s mind ran through the endless cast of characters in Sammy’s alternate reality. “Our half-brother, Adam?” 

The Adam in Sam’s head was one of the few characters who Dean didn’t think had a real-world counterpart; who hadn’t been “assimilated”, and as far as Dean could tell had always just existed.

“What? No. No, Adam’s not our half-brother. He’s my cousin, but… But he’s not your cousin, right?” He squeezed his eyes shut, his face pained as though trying to figure it all out was actually physically taxing. “But that’s can’t be, right? That doesn’t work. Doesn’t make sense.” His spoken thoughts were becoming desperate, panicked. “It doesn’t fit. It doesn’t fit. It doesn’t fit.” He repeated it, his voice tinged with fear, and it was so strange to Dean that the closest he had seen Sam to a psychotic episode was when he was in the _real_ world. “It…this isn’t real. It doesn’t fit.”

“No! Sammy!” Dean grabbed at Sam’s hand; didn’t know what else to do. “Sammy, stay here. Don’t you leave me; don’t leave again.” But even as he said it, he could see that awareness fading in Sam’s eyes. “Dammit, Sam!”

**_~~. wake .~~ _ **

_”Dammit, Sam, this whole thing is spinning out of control. All right? You’re immune to some weirdo demon virus, and I don’t even know what the hell anymore. And you’re pissed at me, I get it. That’s fine, I deserve it. But we lay low until we figure out our next move, okay?”_

_“Forget it.” Sam’s head was spinning in confusion and betrayal. Dean might have to kill him. The air had a strange, artificial quality to it, as though the world as a whole had been dimmed. But why? It had been so bright a moment before, in that flash._

_“Sam, please, man. Hey, please. Just give me some more time. Give me some time to think, okay? I’m begging you here, please. Please.”_

_Sam nodded reluctantly._

**_~~. wake .~~ _ **

“Sam, please, man.”

Searing pain shot through Sam’s hand and he gasped as the world around him flickered. He looked at his hand. Nothing. But the pain had been so real. Real in a way that he’d never really experienced before, although it tickled something in his memory. 

He stared at his palm, brows knitted as the pain continued. He blinked. Dean was holding his hand, thumb pressed into a deep cut that arched across the soft flesh. 

“Just when you thought you were out, they pull you back in, huh, Sammy?” His voice sounded distorted, weaving in and out of Sam’s mind.

**_~~. wake .~~ _ **

_“So, that's it? That's your response?” Sam couldn’t believe it. He had figured that when you told your brother the devil wanted to jump your bones, you were entitled to expect a little bigger of a reaction._

_“What are you looking for?” Dean’s voice sounded weary over the phone, distant._

_“I don't know. A—a little panic? Maybe?” Something. Something to show that he hadn’t given up on Sam. That he still cared about Sam._

_“I guess I'm a little numb to the earth-shattering revelations at this point.”_

_“What are we gonna do about it?” They had to do something about it. Dean couldn’t give up on him._

_“What do you want to do about it?”_

_“I want back in, for starters.” He tried to keep his voice calm, even as something inside of him was screaming that no, he wanted out. He wanted back out. But to where?_

_“Sam…”_

**_~~. wake .~~ _ **

"Sam..." Dean didn't get to finish his sentence before Dr. Winchester had grabbed him roughly by the shoulder of his scrubs and nearly tossed him into the conference room a few feet to their right.

“Are you out of your mind?”


	3. Muddy the Water

_Crazy as it sounds you wont_   
_feel as low as you feel right now_   
_At least that’s what I've been told by everyone_   
_I whisper empty sounds in your ear_   
_and hope that you won’t let go_   
_Take the pieces and build them skywards_

_Cause I’ve started falling apart_  
_I’m not savoring life_  
_I’ve forgotten how good it could be_  
_To feel alive…_  


—Biffy Clyro, “Machines” 

**_~~. wake .~~ _ **

**From Dean Smith’s Journal – 27 July 2013**

_It’s my weekend with Ben. I picked him up yesterday after work. He spent the whole damned hour in the car talking about his dad. Not me. I guess I deserved that. I don’t know how to relate to him. I’ve seen too much awful shit happen to kids, and it’s all I can see when I look at him. I guess that’s automatic entry to the list of people who shouldn’t be fathers._

_In Afghanistan, kids would come up to us and ask for candy. I always kept Jolly Ranchers in my pocket, because they didn’t melt as easily as other stuff and it was hotter than hell. And the kids were nice, and they weren’t as scared of us as you might think—most of them, anyway. But that was kind of alarming because you can’t get it out of your head that maybe they’re not scared of you because they have a bomb strapped to their chests._

_So I guess I’m sort of scared of Ben. Scared for Ben. I don’t sleep well; and maybe I’m just like Sammy, ’cause sometimes there’s this blur and I forget what’s now and what’s then and there’s nothing to ground me._

_Except around Sammy I don’t forget. He needs me to keep my feet on the ground._

_Ben doesn’t need me anymore. He’s got his new dad._

**_~~. wake .~~ _ **

**The Florence Nightingale Pledge** _sworn by nursing students upon completion of their license_

“I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.” 

**_~~. wake .~~ _ **

“What the hell, Dean?” Dr. Winchester looked horrified. “What were you doing?” 

“He came out of it, doc. Swear to god, he was _here_. Actually _here_.” Dean knew he was in deep shit, but he couldn’t help the rush of excitement at the sudden change in Sam’s state. “You know what this means? We can snap him out of it and bring him into the real world and figure out all this bullshit—” 

“What you did is so unethical that I could have your license yanked out from under you before you even realized it was happening.” Dr. Winchester didn’t seem nearly as excited about the progress as Dean was. “Are you kidding me? Digging into an open wound on an individual in your care?” 

“Okay, I know it’s not ideal but—” 

“Ideal? It’s not even _legal_ , Dean!” 

“I’m not saying we torture the kid; I’m just saying that it shows that physical approaches to treatment might help more than those god-awful meds or this sitting around talking about his feelings bullshit, when you and I both know that he doesn’t even understand his feelings because he doesn’t even know what’s really happening—until _now_. How can you not want to do something with this?” Dean was legitimately confused. Sure, maybe actually causing _physical trauma_ was a little extreme, but the point was to provide Sam with parts of reality that couldn’t be assimilated, could wake him up. A pill wasn’t going to do that. His mind would adjust to it, and the problem just got worse when Sam was on them. 

“I _am_ doing something. Believe it or not, I want to see him walk out of here. Maybe more than you do. I’ve been treating him for _ten years_.” Dr. Winchester took a steadying breath. There was a pause before he started speaking again, looking as though he were bracing himself for something irritating and unpleasant. “I started him on a new trial med this evening.” 

“Jesus Christ—you know how he reacts to antipsychotics.” 

“He is _psychotic_. What would you have me do? Carve the kid up and see if the physical trauma outweighs the psychological?” 

“How about you actually treat him? Act like you give a damn?” Dean’s voice was growing louder. “I know he’s just a case files to you; some problem to be solved. But he’s a real person and _we’re failing him_. Shoving those pills down his throat isn’t going to do a damned thing. We’ve gotta snap him out of this and deal with whatever trapped him in there in the first place!” 

“You think you’re _helping_ him? You’re feeding his delusions!” There it was. The two of them had been having this argument for three long years. “You’re too close to him; how is he supposed to get any better when big brother Dean is there to tell him he’s right all the time?” 

“Oh, screw you!” 

There was a beat of silence as both men glared at each other. Dean was pretty sure if it wasn’t for the fact that Sam only trusted Dean—wouldn’t even let most of the other nurses around him—he would’ve been fired that very minute. 

John’s voice was tense, purposefully calm and quiet. “I don’t really care what you have to say about it. I’m Samuel’s physician. I’ll decide what’s best for his care. You do remember your pledge, right?” 

“Fuck the Nightingale Pledge. I don’t pass my life in purity or abstain, either, and I have no fucking idea what deleterious even means. The only part of it I give a crap about is the last bit.” Dean narrowed his eyes. “And you should, too. After all, your oath swore to first do no harm. Those pills are gonna kill him one day. Or make him do it himself.” 

“I’d’ve thought you would know how to show more respect for your superiors. Did you walk around questioning your chain of command in the Corps?” 

Dean could’ve punched the man in the face. Instead he crossed his arms, glaring at him. If looks could kill, the doc would already be buried. “The men and women in the Corps deserved my respect. They earned it; paid for it in blood. But if it was a question of protecting one of my brother’s lives? You bet your ass I’d question ‘em.” 

“I’m only gonna tell you this once—leave Sam’s treatment to me; distance yourself before you make him worse.” 

The doctor pushed past Dean before he could respond, slamming the door of the room behind him. 

Dean was mad enough to break something. He paced a few times, trying to work off the aggressive energy, and then kicked the cinderblock wall. All that did was cause pain to radiate up through his good leg. Unfortunately, his reality was intact, and he’d have to deal with it. 

**_~~. wake .~~ _ **

_”Hey. Wake up, sunshine.” Lucifer’s voice was a mock-soothing lilt. “Up and at ‘em, atom man.”_

_“Sammy.” This voice was Dean’s. He reached out and put his hand on Sam’s chest. “Sammy, hey—”_

_Sam jolted awake, startled as he tried to figure out where he was and what was going on. Bobby’s. He was at Bobby’s. He’d been sleeping on the couch. Relief seeped through his muscles._

_Dean looked as surprised as Sam felt at the abrupt awakening. “That’s twelve hours straight. I’m calling that rested.” He handed Sam a bottle of water and a protein bar. “Here. Hydrate and uh…protein-ate.”_

_Sam smirked. “Breakfast in bed?”_

_“Don’t get used to it.” Dean held his hand out. “Let me see that hand.”_

_Lucifer pretended to be touched. “Oh, he wants to hold your widdle hand. How sweet.”_

_Sam ignored him, focusing on Dean as he removed the bandages on his cut hand. Sam was still trying to make sense of the oddity of the injury—its lack of visibility, the strange jump back-and-forth between places, Dean’s strange reactions to him._

_After a moment Dean seemed satisfied. “Eh, you’ll live. Here.”_

_Sam wasn’t expecting the straight whiskey that Dean poured over the wound and he hissed in pain._

_“Alright, take it easy._

**_~~. wake .~~ _ **

“Alright, take it easy.” Dean shook his head. “It’s just antibacterial spray, you big baby.” 

Dean’s gazed flickered up to Sam’s face. It was the next morning, and according to evening and night shift’s notes, the man had been out of it for half a day. He had missed breakfast, had missed morning group. Apparently evening shift had woken him for med pass, but other than that, he’d been dead to the world. It was better than some of his reactions to other meds they had tried. 

“Antibacterial spray?” Sam looked confused. 

“Well, yeah. What’d you think?” And then Dean saw it. Saw that flicker of awareness for a moment. “Sammy?” 

“What’s going on, Dean?” Sam’s eyes kept moving to glance at the doorway to the room. 

Dean twisted around, checking to see if Dr. Winchester was there or something. The doorway, and the room, were empty. “What do you mean, what’s going on?” 

“We were at Bobby’s, and Lucifer was…” His eyes moved between Dean and the doorway again. “I don’t know if I’m still in the cage or if this is real or… What’s happening to me?” 

Dean watched Sam’s eyes shift back and forth again, and then it hit him. “Wait. Are you seeing him right now?” Sam nodded and Dean swallowed, trying to choose his words carefully. But hell, words were never his thing. Better just get it out there. “You know he’s not real, right?” 

Sam paused before answering, as though listening to someone. “He says the same thing about you.” 

And it was terrifying. It was terrifying and heartbreaking but it was the first time that Sam had acknowledged whether something _could_ be real or not—the first time that he had acknowledged any inconsistency in his fantasy world and the real world. 

Sam was seeing both. Trying to pick them apart. 

**_~~. wake .~~ _ **

_”Okay, if this is some dream and you got power over it, why don’t you just end it?” Sam squeezed his eyes shut, trying to coax them to work right. Dean was flickering, changing. Hunting gear to scrubs. Indifferent to heartbreakingly hopeful. Back and forth._

_Lucifer looked surprised that he would suggest such a thing. “End it? This? You not knowing what’s real, the paint slowly peeling off your walls? C’mon, man, this is the sweet spot!” The angel grinned at him. “Why would I end it? Not like we got HBO in the pit. All I got is you, floating over the coals with half a hope that you’re gonna figure it all out.”_

_Sam glared at him. The devil smiled back._

_“There’s only one way to figure it out, Sam. It’s up to you.” Lucifer’s tone suggested he was imparting a very important revelation to him, but Sam’s heart sank, knowing the answer even before he was told. “It ends when you can’t take it anymore. I think that’s maybe why we’re cleaning our guns.”_

_“Shut up.” Sam’s gaze moved to the weapon he had been cleaning. It flickered in and out of view. There, gone. Real, not real. Which one?_

_Lucifer opened his mouth to say something, but Sam stood up. “I said_ shut up!” 

The flickering stopped. Everything stilled. Dean, dressed in scrubs, was sitting on a hospital bed, leaned backwards slightly in shock at the sudden movement. 

“Hey, Sammy. You uh…having a little bag lady moment?” Dean looked alarmed, and somehow…hopeful? Sam couldn’t figure it out. 

He looked around. He was in a hospital room. He had seen it before. Knew he had seen it before. And yet he still couldn’t _remember_ it. 

What the hell was going on?


End file.
